Tuesday, March 24, 2015

WORLD TB DAY : 24th MARCH 2015

Today, 24th March 2015,  is being observed as 'World TB Day" . It  commemorates the day in 1882 when Dr Robert Koch astounded the scientific community  at the University of Berlin's Institute of Hygiene by announcing that he had discovered the cause of tuberculosis, the TB bacillus.    At the time of Koch's announcement in Berlin, TB was raging through Europe and the Americas, causing the death of one out of every seven people. Koch's discovery opened the way toward diagnosing and curing tuberculosis.

What  happened on 24th March 1882 :

On the evening of 24 March 1882, Robert Koch  announced to the Berlin Physiological Society that he had discovered the cause of tuberculosis. He had conclusively stained bacilli in lung tubercles from animals infected with tuberculosis, a discovery that proved to be a turning point for the scientific world in understanding the deadly disease that had plagued humankind for millennia. Robert  Koch  began by reminding the audience of terrifying statistics: "If the importance of a disease for mankind is measured by the number of fatalities it causes, then tuberculosis must be considered much more important than those most feared infectious diseases, plague, cholera and the like. One in seven of all human beings dies from tuberculosis. If one only considers the productive middle-age groups, tuberculosis carries away one-third, and often more."

Koch's lecture, considered by many to be the most important in medical history, was so innovative, inspirational and thorough that it set the stage for the scientific procedures of the twentieth century. He described how he had invented a new staining method and demonstrated it for the audience. Koch brought his entire laboratory to the lecture room: microscopes, test tubes with cultures, glass slides with stained bacteria, dyes, reagents, glass jars with tissue samples, etc.  He wanted the audience to check his findings for themselves. Koch showed tissue dissections from guinea pigs which were infected with tuberculous  material from the lungs of infected apes, from the brains and lungs of humans who had died from blood-borne tuberculosis, from the cheesy masses in lungs of chronically infected patients and from the abdominal cavities of cattle infected with TB. In all cases, the disease which had developed in the experimentally infected guinea pigs was the same, and the cultures of bacteria taken from the infected guinea pigs were identical. 

One important scientist in the audience was Paul Ehrlich (Nobel Laureate in Physiology or Medicine in 1908) who later confessed, "I hold that evening to be the most important experience of my scientific life." According to Paul Ehrlich, “At this memorable session, Koch appeared before the public with an announcement which marked a turning-point in the story of a virulent human infectious disease. In clear, simple words Koch explained the aetiology of tuberculosis with convincing force, presenting many of his microscope slides and other pieces of evidence.” 

When Koch ended his lecture there was complete silence. No questions, no congratulations, no applause. The audience was stunned. Slowly people got up and started looking into the microscopes to see the TB bacteria with their own eyes.

The Origin and Purpose of the World TB Day : 

In 1982, on the one-hundredth anniversary of Robert Koch's presentation, the International Union Against Tuberculosis and Lung Disease (IUATLD) proposed that March 24 be proclaimed an official World TB Day. This was part of a year-long centennial effort by the IUATLD and the World Health Organization under the theme “Defeat TB: Now and Forever.” World TB Day was not officially recognized as an annual occurrence by WHO's World Health Assembly and the United Nations until over a decade later. In 1996, WHO, KNCV, the IUATLD and other concerned organizations joined to conduct a wide range of World TB Day activities. 

The world TB day aims  to spread the public awareness  of tuberculosis and the initiatives to control it and cure it. To do so,  a theme is identified every year .
Following discussions and consultation with partners, the Stop TB Partnership has announced the theme for World TB Day 2015. The overall theme will continue on from 2014 -- Reach the 3 Million. The main sub-theme and message for this year will be "Reach, Treat, Cure Everyone".

World TB Day 2015, emphasizes  on all partners to for a global effort to continue their commitment to find, treat and cure all people with TB and accelerate progress towards the bold goal of ending TB by 2035.  This World TB Day 2015 will signal a renewed effort to alert health authorities  to the global, regional and national TB emergency, emphasizing the unacceptable situation that many cases of TB go undiagnosed, untreated or are not cured. It is a chance to engage with National TB Programme Managers and other stakeholders to improve the quality of existing programmes and the access to care and services.


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 Call for a world free of TB
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  Reach the three million A TB test, treatment and cure for all

From the CDC : 

Historical Perspectives Centennial: Koch's Discovery of the Tubercle Bacillus

On March 24, 1882, Robert Koch announced to the Berlin Physiological Society that he had discovered the cause of tuberculosis. Three weeks later, on April 10, he published an article entitled "The Etiology of Tuberculosis" (1). In 1884, in a second paper with the same title, he first expounded "Koch's postulates," which have since become basic to studies of all infectious diseases. He had observed the bacillus in association with all cases of the disease, had grown the organism outside the body of the host, and had reproduced the disease in a susceptible host inoculated with a pure culture of the isolated organism. 

Koch continued his studies on tuberculosis, hoping to find a cure. In 1890, he announced the discovery of tuberculin, a substance derived from tubercle bacilli, which he thought was capable of arresting bacterial development in_vitro and in animals. This news gave rise to tremendous hope throughout the world, which was soon replaced by disillusionment when the product turned out to be an ineffective therapeutic agent. Tuberculin later proved to be a valuable diagnostic tool.
In 1905, when Koch was awarded the Nobel Prize in medicine, he devoted his acceptance speech to promoting greater understanding of tuberculosis and its causative agent. Koch died in 1910, leaving the scientific community and the world in general with a valuable inheritance of knowledge and understanding resulting from his seminal work on anthrax, cholera, trypanosomiasis, and especially tuberculosis. 

In the wake of Koch's discoveries, subsequent progress in conquering tuberculosis has been relatively slow. In the laboratory, recognition of the avian bacillus by Nocard in 1885 and differentiation of bovine and human tubercle bacilli by Theobald Smith in 1898 laid the groundwork for identification of other (nontuberculous) mycobacterial species. Diagnosis of tuberculosis was aided by discovery of the acid-fast nature of the bacillus by Ehrlich in 1882, discovery of X rays by Roentgen in 1895, development of the tuberculin skin test by Von Pirquet and Mantoux in 1907-1908, and preparation of purified protein derivative (PPD) of tuberculin by Seibert in 1931.
In the 1930s, the epidemiologic work of Wade Hampton Frost led to a better understanding of the epidemiology of tuberculosis. In the 1940s, using Seibert's PPD administered by the Mantoux method and chest X-ray examinations, the United States Public Health Service began a series of studies that elucidated further the epidemiology of tuberculosis and made apparent the distinction between tuberculous infection without disease (a positive skin test in the absence of signs and symptoms) and overt clinical tuberculosis. 

Treatment has progressed from bed rest, special diets and fresh air, through pneumothorax and other lung-collapse procedures and surgical resection, to specific chemotherapy (streptomycin in 1947, para-aminosalicylic acid in 1949, isoniazid in 1952, and drugs such as rifampin in recent years). With combinations of modern drugs properly administered, tuberculosis is now virtually 100% curable. 

Prevention of tuberculosis has been approached in 2 ways. In 1921, Calmette and Guerin developed an attenuated strain of Mycobacterium bovis, which many countries throughout the world have used, with variable results, as a vaccine. The other major approach to prevention has been the treatment of persons with subclinical tuberculous infection (tuberculous infection without disease) with isoniazid. 

There have been recent improvements in tuberculosis-control methodology. Effective treatment regimens of 9 months' duration are now available, and research continues in attempts to further shorten treatment. Fluorescence microscopy has made the examination of sputum smears faster, easier, and more accurate. Phage typing is a useful tool for studying the epidemiology of tuberculosis. Newer immunologic techniques offer promise of improved diagnostic tests, and rapid radiometric methods of identifying M. tuberculosis and testing for drug susceptibility are being developed. 

In the century since Koch's discovery, advances in prevention, diagnosis, and treatment of tuberculosis--especially treatment--have produced a spectacular decline in tuberculosis mortality and a striking decline in tuberculosis morbidity--primarily in technically advanced countries (Figure 1). Progress has been less dramatic in developing countries. Tuberculosis stubbornly persists as a major worldwide health problem. It is estimated that as many as 10 million cases of tuberculosis may occur throughout the world each year--4-5 million of them highly infectious, and 2-3 million resulting in death. Eradication of tuberculosis, although possibly attainable in technical terms, remains an elusive goal. Reported by Tuberculosis Control Div, Center for Prevention Svcs, Mycobacteriology Br, Bacterial Diseases Div, Center for Infectious Diseases, CDC.


1.      Koch R. Die Atiologic der Tuberkulose. Berliner Klinische Wochenschrift 1882; 15:221-30.

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